northwestgynaecology.co.uk

www.omondihealthcare.comwww.northwestgynaecology.co.uk

North West Gynaecology

Gynaecology Update Symposium

24 April 2013

North West Gynaecology… North West Gynaecology (NWG) is a group of consultant

gynaecologists formed in 2007 to cover the complete spectrum of gynaecological problems.

Gynaecology has many sub-specialist areas and it is no longer possible for one gynaecologist to be an expert in all these areas.

NWG provides a unique service making sure that your patient sees the right gynaecologist to treat their particular problem.

NWG provides comprehensive general gynaecological and subspecialist gynaecological care to the women of Manchester, Cheshire, Lancashire and the rest of the UK

North West Gynaecology…

Ambulatory Gynaecology

Paediatric and Adolescent Gynaecology

Infertility and Assisted Conception

Urogynaecology

Gynaecological Cancer

North West Gynaecology…

Kristina Naidoo

Gail Busby

RickClayton

Edmond Edi-Osagie

TonySmith

…The Team

www.northwestgynaecology.co.uk

Programme… Menstrual Disorders in General Practice

- Dr Kristina Naidoo

Common Problems in Paediatric and Adolescent Gynaecology - Dr Gail Busby

Management of the Infertile Couple - Assessment, Investigation, Referral- Dr Edmond Edi-Osagie

Management of female urinary incontinence - new NICE guidelines - Dr Tony Smith

Update on Gynaecological Cancer- Dr Rick Clayton

Panel Discussion - NWG Faculty

www.omondihealthcare.com

The Infertile Couple…

Edmond Edi-Osagie

Consultant GynaecologistSaint Mary’s Hospital

Manchester

…Assessment, Treatment, Referral

Infertility…some facts

85% of couples conceive after 12 months of UPSI

92% of couples conceive after 24 months of UPSI

1-in-6 (15%) of couples experience some difficulty conceiving WHO, 1975

17.2% prevalence of subfertility among 14,141 couples Collins, 1995

Female fertility…1

Courtesy of: www.repromed.com

Female fertility…2

Courtesy of: www.rba-online.com

Infertility causes…NICE 2013Sperm abnormalities

(30%)Low count

Poor movement

Abnormal shapes

No sperm

Ovulation problems (25%)

Ovulation absent

Poor egg quality

Ovarian failure

Tubal problems (20%)Tubes blocked

Tubes distorted

Tubes absent

Uterine problems (10%)Fibroids

Septum

Adhesions, Polyps

Unexplained (25%)No cause found

Combined (40%)Male and Female

Investigating Infertility…OVULATORY / OVARIAN FUNCTION

..FSH / LH / Oestradiol / Progesterone / Prolactin / Androgens / AMH..

TUBAL FUNCTION

..HyCoSy / HSG / Laparoscopy..

UTERINE CAVITY

..Transvaginal scan / Hydrosonography / Hysteroscopy..

SPERM FUNCTION

..Semen analysis / Sperm DNA damage / Anti-sperm antibodies..

?OTHERS

..?Uterine Doppler / ?Immunological tests / ?Anti-Phospholipids Abs..

Sequellae of PID…I

• Morbidity / Mortality

• Infertility (14x)

• Ectopic pregnancy (6x)

• Chronic pelvic pain (10x)

• Risk of hysterectomy

Sequellae of PID…II

Fertility Advice…• Age: fertility @ 3 years = 94% of 35 year olds vs. 77% of 38 year olds

• Coital frequency: 2-3x weekly (avoid timed intercourse)

• Alcohol: excessive intake detrimental

• Smoking: detrimental to male and female fertility

• Body weight: Ideal BMI = 19-29

• Caffeine: uncertain impact in natural conception; detrimental to IVF treatment

• Drug use: best avoided if not essential

• Complementary therapies: potentially beneficial but no robust evidence

Fertility Treatment Options…OVULATORY DYSFUNCTION…OVULATION INDUCTION

..Clomid / Metformin / Gonadotrophins / Ovarian drilling..

TUBAL FACTORS…SURGERY

..Tubal canulation / Peri-tubal adhesiolysis / Cuff salpingostomy / IVF-ICSI..

UTERINE FACTORS…SURGERY

..Metroplasty / Adhesiolysis / Fibroid/Polyp resection..

SPERM DYSFUNCTION…AC

..IUI / SSR / IVF-ICSI..

?OTHERS

..?Immunotherapy / ?Steroids / ?Complementary therapies..

Assisted Conception (AC)…

..IUI / S-IUI / DI..

..IVF..

..ICSI..

..Gamete Donation..

..Surrogacy..

AC access by PCT…1

AC access by PCT…2

NICE guidelines 2013…I

Offer infertility investigations after 12 months of

trying to conceive (down from 24 months)

Offer infertility investigations earlier if the woman

is >36 years and/or there is a known cause of

infertility

NICE guidelines 2013…II Do not offer Clomid treatment for unexplained

infertility

Do not offer IUI (natural or stimulated) routinely

for Unexplained infertility, Endometriosis, or Mild

male factor infertility

Offer IVF treatment after 2 years of unexplained

infertility www.northwestgynaecology.co.uk

NICE guidelines 2013…III

Offer 3 full cycles of IVF after 2 years of infertility

up to the age of 40 years

Offer 1 full cycle of IVF between 40 and 42 years

to women with satisfactory ovarian reserve who

have not previously had IVF

…how can NWG help!

NWG Fertility Services...I

Service Model

..Private Satellite Fertility Service..

Licensed Centres

..St. Mary’s Hospital, Manchester..

..Manchester Fertility Services..

NWG Fertility Services...II

..fertility profiling..

..comprehensive investigations..

..full range of fertility treatments..

..surgical treatment options..

..support & counselling..

NWG Fertility Treatments… General = Fertility Profiling & Advice..

Medical = Ovulation induction (Oral & Parenteral)..

Surgical = Tubal surgery, Reversal of Sterilisation,

Ovarian drilling, SSR, Uterine surgery..

AC = IUI, IVF, ICSI..

Egg freezing / donation / sharing / Surrogacy..

www.bmihealthcare.co.uk

Discussion

www.bmihealthcare.co.uk

northwestgynaecology.co.uk

Documents

Transcript of northwestgynaecology.co.uk

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